Lisinopril (Prinivil, Zestril) is one of the most commonly prescribed blood pressured medications in the world. It belongs to a class of drugs called ACEis (angiotensin converting enzyme inhibitors) that includes:

  • Benazepril (Lotensin)

  • Captopril (Capoten)

  • Enalapril (Vasotec)

  • Fosinopril (Monopril)
  • Lisinopril (Prinivil, Zestril)

  • Moexipril (Univasc)

  • Perindopril (Aceon)

  • Quinapril (Accupril)

  • Ramipril (Altace)

  • Trandolapril (Mavik)

Such drugs are effective for helping control hypertension and many people take these medications without experiencing any side effects. That’s the good news.

The bad news is that some people are susceptible to a potentially lethal complication of ACE inhibitors called angioedema. In this condition tissues around the face and neck can swell rapidly. Without immediate emergency treatment angioedema can be life threatening. The symptoms can surface within a few hours or days after starting on the drug. But even people who have been on an ACE inhibitor for months or years can develop angioedema.

At the very first symptoms of swelling do not delay: CALL 911 and be transported to an emergency department instantly! Don’t just take our word for it. Here is a recent report posted to our website from Dennis:

“On October 8 I saw my doctor and was prescribed 20 mg of lisinopril 3 times a day. I thought, ‘Great, now I have some meds to help with my high blood pressure.’ I think I was around 185 over 110 which the doctor said was pretty high.

“By the 12th of October my tongue had been swelling every day to the point that breathing was getting very difficult. This was all happening by the fourth day of taking my new blood pressure medicine.

“My son took me to the ER on the 12th. The nurse in ER took my readings and said my blood pressure was in heart attack territory at 225 over 170. I was taken back to a room to be examined, as my tongue was swelling so much. Not one doctor knew what to do. I really thought I was going to die from suffocation, as breathing was almost impossible at this point.

“By this time other family members were arriving and for two weeks I don’t remember anything other than what I was later told by family and doctors. The doctors put me in an induced coma. Doctors had to do surgery and perform a tracheotomy so I could breathe during my coma.

“They diagnosed me with angioedema caused by taking lisinopril!

“During my coma I developed pneumonia and also had to be put on dialysis. The doctors told my family that they should all be nearby because I wasn’t expected to live through this ordeal. They told family members only about a half percent of patients make it through a situation like mine.

“When I woke up from my coma after two weeks I couldn’t walk, talk, or even write a simple sentence. I started my therapy in the hospital and it sure was difficult. After great hospital care and help from family and rehab I was able to walk and talk and write again. It seemed like it took forever but my goal was to do my rehab and be home by Thanksgiving. I pushed hard and did accomplish my goal but I don’t think I deserved to almost die and lose two months of my life for something that was not my doctor’s fault or mine.

“When my doctor saw me next he let me know he was so sorry and told me he kept checking up on my health daily. He even cried when we talked about my ordeal. People taking lisinopril need to know about the hazards of this drug.”


Dennis was lucky indeed to have survived. His angioedema reaction came on within days of starting lisinopril. Other people may let down their guard because they have taken an ACE inhibitor safely for years. Here is Ruth’s story:

“My brother was on lisinopril for two to three years with no problems other than a irritating cough. However, last month, he woke up with a very swollen tongue. By the time he got to the ER, his respirations were down to about 85% and he was having trouble talking.

“The ER called for an emergency triage and the ER doctor came out, rushed him into a room, actually helping strip his clothes on the way. They gave him adrenaline, and IVs. They told him if he had been a little later waking up he might not have made it, and that most people with this serious a reaction can end up on a ventilator.

“Don’t mess with swelling of the mouth or trouble breathing. It could be a bad reaction. We are only five minutes from the hospital, and he was terribly close to stopping breathing and ending up on a ventilator.”


 

Symptoms of Angioedema

Any swelling of tissues around the face, mouth and throat are a tip-off that something bad is happening. Some people report numbness or decreased feeling in the affected area. The eyes and lips can also be involved. If the throat and tongue swell, there can be the sensation of throat tightness and breathing can become difficult or impossible.

Abdominal Angioedema

Angioedema is not restricted to the head and neck. Hands and genitals can also be affected. When angioedema strikes the intestines, it can cause abdominal swelling or distension and in some cases bowel obstruction. We have heard from many patients that this condition can be hard to diagnose. Here are some stories:

“I was put on lisinopril for high blood pressure in January. That month I experienced severe stomach cramping and vomiting. I was rolling on the floor in agony. The doctor said it was most likely the flu but started me on two different antibiotics in case it was bacterial.

“A few weeks later I had another attack with severe stomach cramping and vomiting. I went to the ER, where I was given IV pain meds. A CT scan showed small intestine inflammation partially blocking off my bowel. I was sent home but returned the next day with pain that was a 10 on a 10-point scale. The doctor said that all the tests had been done and there was nothing he could do. I was sent home with pain medication.

“A few weeks later I was admitted to the hospital with increased small intestine inflammation and another blockage. I vomited and dry-heaved for 12 hours. I was released four days later with no definitive diagnosis.

“I was told most likely I had Crohn’s disease, but a colonoscopy was negative for Crohn’s. I underwent extensive tests, including endoscopy, and all were negative. None of the doctors made a connection with the drug lisinopril.

“After two months of missing work, three more ER visits and untold suffering, I found several other people who reported similar symptoms connected to lisinopril. I stopped the medication and have not had another attack. If you look on PubMed you can see reports on lisinopril and intestinal angioedema, but doctors don’t think to connect this with lisinopril because it is not listed as a common side effect.”

Another visitor to our website responded: “I feel your pain, trust me. This reaction to lisinopril is the worst pain I’ve ever had, worse even than labor. It was ridiculous that they did so many tests and still couldn’t figure it out for so long.

“I know doctors think this is really rare. I had to look up the exact words ‘intestinal angioedema lisinopril’ to find it online. But I think all of the side effects should be listed. My doctors were considering removing part of my intestine at one point. If only they had realized sooner that lisinopril was the cause, I wouldn’t have suffered so long.”


“I too have been experiencing a lot of mysterious abdominal pain after switching the brand of lisinopril I was taking. After months of abdominal attacks that came with ‘allergic type’ reactions, I finally had to go to the ER because of an anaphylactic reaction.

“I was referred to an allergist who listened carefully and told me that it could be from the lisinopril. It has now been two days since I stopped taking it and I have no abdominal pain at all. I have not been pain free for 5 months and am so grateful for an observant doctor.” N.G.


“Yes this drug does cause angioedema. At least you were lucky enough (considering all you dealt with) to be diagnosed and treated in a few weeks. I had angioedema in my intestine and it took over two and a half months for doctors to figure out that it was the Lisinopril because it’s such a rare reaction. They couldn’t believe I didn’t have the swelling in my mouth, throat, etc. as well.

“I don’t blame the doctors because not everyone reacts to medications the same. Unfortunately you don’t know if you’re allergic until you take it. There were only 22 reports of my allergy to it from 2000 to 2010 out of 80,000+ reports of various side effects.

“I wish pharmacies put the rare reactions on the info they give you about drugs but they usually only list the ‘common’ side effects. I am glad you are better. It’s a long road to recovery. I had two surgeries and spent a month in the hospital because of this medicine.” Christie


ACE inhibitors can trigger other side effects besides angioedema. The most notorious is a dry, hacking cough that is uncontrollable with cough medicine. This cough can be terribly disruptive and lead to vomiting. Getting a good night’s sleep can be challenging if you are susceptible to an ACEi-induced cough. To read more about this surprisingly misdiagnosed adverse drug reaction, check this link.

ACE INHIBITOR (LISINOPRIL) SIDE EFFECTS:

  • Dry cough, uncontrollable cough, nausea, vomiting
  • Dizziness, excessively low blood pressure
  • Kidney function changes, BUN & creatinene elevations
  • Headache
  • Digestive distress, diarrhea, abdominal pain
  • Tiredness, fatigue, malaise
  • Excessive potassium levels (requires immediate medical attention!), irregular heart rhythms, chest pain
  • Elevated uric acid levels
  • Sensitivity to sunlight (photosensitivity), skin rash
  • Angioedema (swelling of face, lips, tongue, throat)
  • Angioedema (swelling in abdomen, severe abdominal pain)
  • Severe allergic reaction (anaphylaxis) requiring emergency treatment
  • Toxicity to liver or pancreas
  • Blood disorders
  • Potential birth defects if taken during early pregnancy
  • Sexual difficulties

 

Anyone who would like to learn more about non-drug approaches to controlling hypertension may find our Guide to Blood Pressure Treatment of interest. There is also information about other medications for dealing with blood pressure problems.

Share your own ACE inhibitor story (positive as well as negative) below in the comment section.

 

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  1. B.Grant
    Reply

    I HAD high blood pressure until I took a concentrated, liquid Resveratrol/antioxidant supplement.
    Now I no longer need my blood pressure medications.
    ~B. Grant, R.N.

  2. GW
    Reply

    My husband had been taking lisinopril for years with no adverse effects but one morning we woke up with horrible welts covering his entire back. It itched a little but looked horrible. We didn’t know if it was a food allergy or what. He is not prone to skin or food allergies. We went to urgent care & they thought it might have been something he ate. They gave him an antiacid & told him to see his regular physician. The doctor was not sure what caused it but changed his BP medication and the welts have never come back.

  3. Lou G
    Reply

    With all due respect to CRL. Anyone that had coughing problems for 8 years should have wondered if something was wrong, unless they were smokers. Those of us that don’t have problems with Lisinopril, as I stated in my comments 07/22, are fortunate. However, if I suddenly develop a medical problem I certainly will try to find the cause as I have a weakened immune system so am susceptible to to whatever will cause a problem. If I have to get a second or third opinion due to a persistent problem I would not wait 8 years to see another doctor.

  4. art
    Reply

    The symptoms that you are describing are the most common (1-10%) listed for Atenolol (a beta blocker) and less common (

  5. MAXINE H.
    Reply

    A few years ago all of a sudden my blood pressure went up and I had to start taking blood pressure meds. Also I found out I have heart valve problems, and an ultrasound found one kidney had atrophied. An MRI, that divulged a renal artery had stopped up some time along the way, so for all intents a purposes I have only one working kidney, am taking 3 blood pressure meds, losartan, carvedelol, amlodipine, and calcitriol, a form of vit d and calcium I think, and also 2-3 times a week 20 mlg, of furosimide[ lasix] and 10 meq, of potassium.
    I am under cardiac Drs. care and also a renal physician. I have to have a big blood test every six months now, it was every three months, to monitor my kidney. This has taken a toll on me as I am now not steady on my feet, always, and I fell over a year ago and fractured my pelvis and broke a rib and had a concussion all in one fall, so be careful if you are unsteady as you will fall, and I nearly killed myself.
    Was in a rehab hospital for two months learning how to walk again. All in all a miserable time, I feel this has shortened my life, I come from long lived ancestors, but I feel like I will not make it to 90 as some of them have, including both grandmothers. I am nearly 85, and was in very good health until all this, so be careful everyone as you can be in a very scary position in one fall. Medicine is good when its right, but I took lisinopril also and had a terrific cough and insisted to my Dr. to give me anything but that, and he did, so I had none of those things that lisinopril can cause except that cough and it was short lived as I insisted I would not take it.
    Also I do not sleep well and I think its too much medicine that I am taking, my Dr. is going to re-evaluate me and see if there is something he can do. Your input is welcome “People’s Pharmacy”, I would appreciate any advice from the two of you. Thanks

  6. CRL
    Reply

    I read the scary stories and the comments form the one who said this should be balanced with success stories. I was one of those who misguidedly thought I was a success story because I was on lisinpril for 8 years and it did lower my blood pressure but I had a persistent cough that I didn’t relate to it and my doctor never told me that it was the lisinpril that caused it. He prescribed cough syrup and had me going to the pharmacy downstairs in his office that didnt’ give insert information so I never made the connection til I got on Medicare and had to change doctors (because he didn’t see medicare patients).
    Thank GOD! My new doctor told me that the cough was a side effect of lisinpril. In the meantime, the constant nagging cough had caused me to wet myself/incontinence (old doctor prescribed for that as well) and a hernia (mild but still could have been avoided) from all the coughing.
    New doc switched me to losartan. Cough went away after 8 yrs!. I got off meds for incontinence, threw away cough syrup and sleep like a baby.
    So don’t be lulled into thinking you are a success story for lisinpril just because you’ve not had a major event. The little things that don’t seem connected can hurt too.

  7. pp
    Reply

    Is Lisinopril the only medication that reports this problem, or does this occur with all the ACE inhibitors?

  8. art
    Reply

    Sotolol is a Beta-Blocker not an ACE Inhibitor. The condition for which you’re taking it are very different from those who are taking ACE Inhibitors. Beta-Blockers have an entirely different side effect profile. Check with the Pharmacist where you get your Sotolol filled for full information about side effects and indications.

  9. Lou G
    Reply

    I too, have been taking 60 MG Lisinopril for many years. When I first began, I was dizzy for many hours during the day and didn’t know why. Eventually my body apparently got used to it and the problem went away.
    Earlier this year I was prescribed Gabapentin as even though I had lumbar surgery in May 2012, I still have back pain and problems with the left leg. The Gabapentin made me very dizzy also so I only took it at night until I got used to it. Then I took it again in the morning and I’d get dizzy for several hours. I wouldn’t take it if I had to drive anywhere. Now, I have no problem taking both Lisinopril and Gabapentin in the morning.
    I’m very happy to read about the swelling problems so if I develop any I will immediately go to the emergency room just in case. As I’ve stated in this forum many times before, not all symptoms of different medications affect all people, nor does medication help some people as it does others. In any case, this forum brings to light problems people have and remedies they find here. But it also highlights potential problems like this possible swelling using Lisinopril even for folks like me thaat have taken it for years. For that I’m grateful.

  10. Nancy V
    Reply

    About 19 years ago I was taking Lisinopril for my high blood pressure. It didn’t seem to lower it so the M.D. added a Calcium Channel Blocker to the mix. Three days later I experienced severe swelling of my throat. It closed up so severely that I felt like I was being strangled; I could not talk enough to make an emergency phone call.
    This might sound nuts, but I recalled my mother giving me honey for croup when I was a child. Fortunately I had some honey, so I groped my way into the kitchen. I kid you not, the honey reduced the swelling and I was able to call my brother who took me to the hospital. After 3 days of observance I was taken off the Lisinopril and put on Norvasc.
    Fast forward to current BP issues. I have been on Amlodipine for years. A year ago Atenolol was added to the mix because of a misdiagnosis of Atrial Fibrillation. I have had swelling and tingling in my lips and even my feet but the M.D’s say, “oh, you must stay on the BP meds; they are helping you. It’s not a common side effect of Betas!” I guess you have to go to the emergency room before the doctors are willing to change whatever it is they prescribe!

  11. DCL
    Reply

    I am now 83 and in pretty good health, but have been taking BP meds, A calcium channel blocker and a beta-blocker. My BP seems to stay about 130/70. Years ago, I was put on Altace, I had a peculiar reaction and my Dr did not believe me. I had so much coughing and mucous that I had to occ. vomit the thick stuff up. Dr tried the Prenisone pack plus an antibiotic of some sort. No help, wanted to try Prednisone again. I changed Drs went off Altace, no problem since. So far the B Blocker 7 CA Channel Blk. has seemed to agree with my system. Meds are like anti depressents, trial and error, in my opinion. Wish, I could drop them all. I have refused most, including statins. !4 years go, they made me weak. I exercise quite regularly, & I am active. My legs are still weaker than they should be.

  12. S.H.
    Reply

    I have tried multiple times, sometimes a year apart, to take lisinopril; reason: it was $3 a month and Diovan was $80+. (I ended up on $58 losartan).
    Eventually, I get that horrid cough; you know, the one that sounds like a circus seal. One time, I went almost two months using the generic that Walgreens dispensed, before the cough took over my 24 hr a day life.
    If I could describe the way it feels, it might help some one else to recognise the symptoms. It feels like a Tarantula is crawling down and up my throat and esophagus area. Now, I’ve never had a tarantula in my throat, but if I ever did, THAT is what it would feel like! When it hits, there are no warning signs; I just grab my throat/neck area and the horrid coughing starts and the spider/creepy/crawlie feeling begins. Sometimes, I cough until I gag…and worse…..

  13. JWR
    Reply

    Several years ago I took one of my mother’s Lisinopril tablets by mistake. I had a severe reaction including swollen face and neck, difficulty swallowing, and abdominal pain. I went to my doctor and he prescribed a regimen of Prednisone which quickly reversed the reaction. He knew exactly what to do.

  14. art
    Reply

    Use celery seed and also, cacao to naturally lower your blood pressure.

  15. Dorothy A.
    Reply

    I’m feeling lucky. In 2013 having been on lisinopril and an ACE inhibitor for 3 months, I went to the ER after living with a persistent cough for weeks. I couldn’t sleep or stop coughing.
    After various tests and stopping the lisinopril the cough faded. At least all I had was the cough, not the swelling. After I started the coughing I had looked lisinopril up on the internet and finally found the coughing side effect listed and stopped taking it. While in the hospital the doctor said I should stop taking it. Duh!

  16. D.M.
    Reply

    I’m a regular reader of the column, and it seems like ACE inhibitors, Beta-blockers, and statins are almost always in the crosshairs of yet another installment, warning us of serious side effects from these drugs.
    I’m ambivalent about all this, because on the one hand, I really dislike the “pill for every ill” mindset of so many medical practitioners and other health care professionals these days. And yet, so much of the “evidence” implicating these drugs for causing serious side effects seems to be anecdotal. Particularly maddening are the stories which do not provide dosage information. Seems to me there’s a HUGE difference between consuming 10mg/day and 40mg/day of a statin, for example. Some goes for the ACE- and beta- drugs.
    Also, it would be helpful to know what the odds are of actually suffering these side effects. What percentage of ACE-inhibitor users, especially at low dosages, suffer any side effects at all? I’m guessing it’s very, very few.

  17. gail
    Reply

    I am taking sotolol for heart rhythm AFib. Its it an ace inhibitor and could I be affected like these other people?

  18. C. F.
    Reply

    I was on low dose Ramipril for 3 years before being awakened one night with angioedema. It can happen anytime over the course of taking this med.

  19. art
    Reply

    I’ve always been on the upper end of the normal blood pressure range. Prior to sinus surgery about 4 years ago, the Doctor performing the surgery put me on Lisinopril, an ACE Inhibitor per hospital protocol a couple of weeks prior to surgery. The surgery went fine and, I stayed on the Lisinopril for several months until I noticed some very disturbing and persistent dreams at night.
    I looked up Lisinopril and found that it’s derived from,”snake venom”, so I discontinued it and the dreams went away. Recently, I was undergoing a cardiac sonogram from a Cardiologist prior to being fitted for a “sleep guard” device by my dentist. The Physical exam showed a slight elevation of my blood pressure on the normal range. The Cardiologist gave me some “blood pressure” medication samples to try. They were “Calcium Channel Blockers”. I took one dose and nearly passed out! I discontinued those as well and returned them to the Doctor. My sonogram and other tests all showed otherwise, normal.

  20. hjl
    Reply

    Just for updates

  21. Penny H.
    Reply

    I started taking Lisinopril around 1999 after steroid shots raised my blood pressure and I was also taking another blood pressure medicine. My PCP retired and I started going to another doctor. I convinced her to stop the other BP med but not the Lisinopril. My current BP runs 95 to 115/55 to 70. My new doctor says the Lisinopril has another good side effect and that I should keep taking it. This scares me because I live alone in a senior apartment complex. I’ll definitely be showing this article to my doctor when I see her next time.

  22. AHD
    Reply

    I’ve been taking Lisinopril for 4 years and now your comments have me very worried. Shouldn’t you balance these reports with success stories?
    PEOPLE’S PHARMACY RESPONSE:
    Dear A.H.D.,
    We specifically have asked for comments (both positive as well as negative) so that there will be success stories too.
    Please go back to the beginning of the article and read this statement:
    “Such drugs are effective for helping control hypertension and many people take these medications without experiencing any side effects. That’s the good news.”
    For those who do not experience a cough or other side effects, ACE inhibitors like lisinopril can be safe and effective.
    Patients must be alert for the symptoms of angioedema, even if they have taken such drugs for several years. That is the point of this article. Many people are not told what the signs of this life-threatening condition can be and might delay going to the emergency department. We hope this information will alert them to take immediate action if swelling occurs.

  23. PLA
    Reply

    I wonder if red hibiscus tea, a natural remedy for hypertension, could also be problematic for these potential side effects? It is my understanding that the antihypertensive mechanism of action for hibiscus tea is thought to be an ACE inhibitor similar to lisinopril.
    I started drinking 2-3 cups of red hibiscus tea daily for blood pressure, and also because it’s caffeine-free and I really like the taste. But I was also using the DASH diet (Dietary Approaches to Stop Hypertension), which, as you know, involves daily consumption of 8-10 servings of veggies and fruits and a couple of servings of low-fat dairy. This is a large intake of potassium, which is probably one of reasons that DASH diet lowers BP. But I began having severe muscle cramps, and since the hibiscus tea was the only new addition to my diet and supplement regimen, I re-read info about it. I learned that ACE inhibitors can cause hyperkalemia, and muscle cramps can be a symptom of elevated potassium. I have used DASH diet successfully for years to control my BP, despite being obese and sedentary, so I chose to stop the hibiscus tea. The problem muscle cramps resolved. I occasionally drink a cup of hibiscus tea at night when I want a caffeine-free warm beverage, but I will rely on some of other natural approaches (beets, dark chocolate, lots of leafy greens, low-carb/low glycemic diet) in addition to DASH diet for BP control.
    Thanks for all the helpful info you guys bring us.

  24. blk
    Reply

    About five years ago I went to the ER and was diagnosed with hyponatremia [low sodium levels]. I had been taking Lisinopril for several years with no pronounced side effects. Stayed in the hospital for a few days with an IV and went home. It was a hot August, but I am not a jogger or marathoner.
    Two months later I was back again with hyponatremia. Another IV, then release; my PCP had no ideas and wasn’t even curious.
    When the symptoms reappeared two months later, I refused the ER, sat down at my computer and googled for hours. ACE inhibitors suppress angiotensine, which affects not only blood vessels, but also signals the kidneys to balance your electrolytes. No help here from the medical community so I swore off Lisinopril for two weeks, walked into an urgent care, asked for blood work. Electrolytes (salt) were normal.
    The only person who acknowledged the problem was a local pharmacist. It’s documented more widely now, and seems to occur mostly in the elderly. The MDs weren’t even interested in looking for a cause although the pharmacists did care.

  25. JFR
    Reply

    This is a really scary story! I have been taking lisinopril for years.
    I am elderly and my blood pressure runs anywhere from 150/80 to 190/90 even with the lisinopril: 10 mg twice a day. I tried several drugs before lisinopril and they had unbearable side effects. Does anyone know the percentage of cases this awful side effect happens?
    PEOPLE’S PHARMACY RESPONSE:
    It is very rare…though hard to document exactly how rare. For those taking lisinopril without side effects there is relatively little worry. Just be alert if there is ever facial swelling or swelling of any part of the body such as tongue or genitals. Any difficulty speaking is another early warning sign.

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